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Transmission of Monkeypox Among Persons Exposed to Infected Prairie Dogs in Indiana in 2003
James C. Kile, DVM, MPH, DACVPM;
Aaron T. Fleischauer, PhD, MPH;
Bradley Beard, BS;
Matthew J. Kuehnert, MD;
Richard S. Kanwal, MD, MPH;
Pamela Pontones, MA;
Hans J. Messersmith, MPH;
Robert Teclaw, DVM, MPH, PhD;
Kevin L. Karem, PhD;
Zachary H. Braden, BS;
Inger Damon, MD, PhD;
Ali S. Khan, MD, MPH;
Marc Fischer, MD, MPH
Arch Pediatr Adolesc Med. 2005;159:1022-1025.
Objective To describe a cluster of human monkeypox cases associated with exposure to ill prairie dogs in a home child care.
Design, Setting, Participants We identified all persons exposed to 2 pet prairie dogs in County A, Indiana; performed active surveillance for symptomatic monkeypox infection; and evaluated the types of exposure that may have resulted in infection. For children who attended the child care where the animals were housed, we also measured the rate of seroconversion to monkeypox virus.
Main Outcome Measures Nine (13%) of 70 persons exposed to the prairie dogs reported signs and symptoms of monkeypox. Two (40%) of 5 symptomatic child care attendees reported direct contact with the prairie dogs. Two (13%) of 15 child care attendees evaluated tested positive for IgM antibodies against orthopoxvirus; both reported symptoms consistent with monkeypox.
Results The risk of symptomatic infection correlated with the time and intensity of animal exposure, which was 100% (4/4) among family members with extensive direct contact, 19% (5/26) among the veterinarian and nonfamily child care attendees with moderate exposure, and 0% (0/40) among school children with limited exposure (P<.01).
Conclusions Monkeypox virus was transmitted from ill prairie dogs in a child care and veterinary facilities. The risk of symptomatic infection correlated with the amount of exposure to the prairie dogs. Although most cases of human monkeypox were associated with direct animal contact, other routes of transmission cannot be excluded.
Author Affiliations: Environmental Health Services Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health (Dr Kile), Bioterrorism Preparedness and Response Program (Dr Fleischauer), and Divisions of Viral and Rickettsial Diseases (Drs Kuehnert and Karem, Mr Braden, and Dr Damon), Parasitic Diseases (Dr Khan), and Bacterial and Mycotic Diseases (Dr Fischer), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga; Information and Policy Commission (Mr Messersmith and Dr Teclaw) and Field Epidemiology (Mr Beard and Ms Pontones), Indiana State Department of Health, Indianapolis; and Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WVa (Dr Kanwal). Dr Kile is currently with the Technical Assistance and Correlation Division, Technical Service Center, Office of Policy, Program, and Employee Development, Food Safety and Inspection Service, United States Department of Agriculture, Omaha, Neb. Mr Messersmith is currently with the Program in Evidence-Based Care, McMaster University, Hamilton, Ontario.
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